Pressure sores, or pressure injuries, are localized areas of damage to the skin and/or underlying tissue, most commonly occurring over bony prominences. These injuries can range from mild skin discoloration to deep wounds that expose muscle and bone. The risk factors are complex, but understanding them is the first step toward effective prevention and management.
Key Populations at Highest Risk
Certain groups are disproportionately affected by pressure sores due to a combination of intrinsic (patient-specific) and extrinsic (external) factors. The inability to move or sense pressure is a primary driver, placing the following populations in a high-risk category:
The Elderly and Those in Long-Term Care
Advanced age is a significant risk factor for pressure sores. As people get older, their skin becomes thinner, drier, and more fragile, making it more susceptible to damage. Many older adults also have less fat and muscle to cushion bony areas. Those in nursing homes are at a particularly high risk, with some studies showing more than 1 in 10 residents have suffered from a bedsore. This is often compounded by limited mobility, malnutrition, and other chronic health conditions.
Individuals with Impaired Mobility or Immobility
Anyone who is unable to move and reposition themselves frequently is at high risk. This includes individuals who are bedridden, use a wheelchair for long periods, or are in a coma or vegetative state. The sustained pressure on the skin, especially over bony areas like the heels, tailbone (sacrum), and hips, restricts blood flow and can cause tissue to die within a few hours. Paralysis from conditions such as spinal cord injury or stroke is also a major risk factor, as the affected individual may not be able to feel pain or discomfort that would prompt them to shift position.
Patients with Chronic Health Conditions
Numerous chronic diseases compromise circulation, sensation, and the body's healing capacity, substantially increasing the risk of pressure sores. Diabetes, for example, can impair both circulation and nerve sensation. Cardiovascular disease and peripheral artery disease also reduce blood flow to the skin and tissues. Other conditions like severe neurological impairments, cancer, kidney failure, and dementia can also heighten risk.
Intrinsic vs. Extrinsic Risk Factors
Pressure sore risk is a complex interplay between a person's health and external forces. The following table compares intrinsic (internal) and extrinsic (external) factors that contribute to the development of pressure injuries.
| Intrinsic Risk Factors | Extrinsic Risk Factors |
|---|---|
| Age > 65: Thinner, less cushioned skin and slower healing. | Pressure: Unrelieved mechanical load on tissues, especially over bony areas. |
| Impaired Mobility: Inability to change positions regularly. | Shear: Skin and underlying bone move in opposite directions, stretching and damaging blood vessels. |
| Decreased Sensation: Conditions like paralysis or diabetes can prevent an individual from feeling discomfort. | Friction: Rubbing against surfaces like bedding, which can cause skin abrasions. |
| Malnutrition: Lack of protein, calories, and nutrients weakens the skin and impairs healing. | Moisture: Prolonged exposure to sweat, urine, or feces can lead to skin breakdown. |
| Incontinence: Continuous moisture and irritants from urine or feces soften and damage the skin. | Medical Devices: Ill-fitting devices, such as casts, oxygen tubing, or catheters, can apply constant, damaging pressure. |
Prevention Strategies for At-Risk Individuals
For those identified as being at risk, several preventative measures are crucial to avoid the development of a pressure sore.
- Regular Repositioning: Individuals who are bedridden should be turned at least every two hours, while those in a wheelchair should shift their weight every 15 minutes. Caregivers should use lifting sheets to avoid friction and shear.
- Skin Care and Inspection: Daily skin checks are vital, especially over bony prominences. The skin should be kept clean and dry, and moisture barrier creams can be used to protect against incontinence. Any redness that doesn't fade should be immediately addressed.
- Use of Support Surfaces: Special mattresses, overlays, and seat cushions—such as foam, gel, or alternating air systems—can help redistribute pressure away from vulnerable areas. Note that doughnut-shaped cushions are not recommended as they can increase swelling.
- Proper Nutrition and Hydration: A balanced diet rich in protein, vitamins, and minerals is essential for maintaining healthy skin and promoting wound healing. In cases of malnutrition, supplements may be recommended by a healthcare provider.
- Early Intervention and Assessment: Healthcare professionals often use standardized risk assessment tools, such as the Braden Scale, to systematically evaluate a patient's risk. A personalized care plan can then be developed based on the findings.
Conclusion
Identifying who is most at risk of developing a pressure sore involves a comprehensive assessment of intrinsic and extrinsic factors. Individuals with impaired mobility, chronic health conditions, advanced age, and poor nutritional status are particularly vulnerable. While pressure sores are a serious and potentially life-threatening complication, they are often preventable with careful and consistent care. By prioritizing regular repositioning, diligent skin care, appropriate support surfaces, and good nutrition, caregivers and healthcare teams can significantly reduce the risk for their patients. Empowering at-risk individuals and their families with this knowledge ensures proactive prevention, which is the most effective approach to managing this serious health issue.
How to Assess Your Risk
For individuals at risk or their caregivers, it is recommended to discuss prevention strategies with a healthcare provider. The National Pressure Injury Advisory Panel (NPIAP) provides resources for both professionals and the public. You can find more information and clinical practice guidelines on their website. https://npiap.com/
Note: The National Pressure Injury Advisory Panel (NPIAP) is a non-profit organization dedicated to the prevention and management of pressure injuries. Its guidelines are widely used by healthcare providers. This link is for informational purposes and not a specific product recommendation.
